In March 2015 the Supreme Court delivered its judgement in the case of Montgomery v Lanarkshire Health Board. The case involved a woman with diabetes whose son was born with serious disabilities after developing complications in labour. However, the judgement is relevant to the practice of every clinician in the UK and improvements within clinical governance.
The judgement makes clear the patient’s right to decide which, if any, available treatment to undergo and consent to, and the duty of the doctor to take reasonable care to ensure that the patient is aware of the material risks involved in any recommended and reasonable alternative treatments. The patient’s right to self-determination trumps the professional’s ‘best interests’ test.
Awareness of this amongst practitioners is variable and understanding of what it means in practice even more so. A mixture of ignorance, confusion, fear and learned helpless creates a potent cocktail of risk for patients, staff and healthcare organisations. But there is also a great opportunity to build trust and respect between different professional groups by introducing team working during training, and in maintaining skills and exercising them.
All clinicians are expected to understand the legal, professional and regulatory framework applying to informed consent and to meet these obligations in practice. Providing training to mixed professional teams brings them together to meet these expectations. It strengthens teamwork and prevents the breakdown of relationships which had such disastrous consequences for care at Morecambe Bay. Patients are safer, staff well-being and job satisfaction is enhanced and reputational risk is protected.